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Pharmacology > CVS Meds Specificity > Flashcards

CVS Meds Specificity Flashcards

Characteristic + Elimination

1
Q

Dobutamine Dynamic; Elim; Specifics, Indicate

A

Dynamic: B1 adrenergic
Elim: Hepatic + Renal
Indicate: Acute CHF 2/2 MI and Septic Induced Cardial Dysfxn.

Specific: Decreases SVR, BP effect is dependent on Preload + Inotropy
Less tachyarrhymia vs dopamine
Tolerance in 3 days
Do not Mix with NaHCO3​ or in pt with AFIB

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2
Q

Dopamine Dynamic; Elim; Specifics, Indicate

A

Dynamic: Dopaimine; B: 3-10 mcg/kg/min; A+B: 10+
Elim: MAO/COMT (monoamine oxidase/ Catechol-o-methyltransferase)
Indicate: Hypotension, acute CHF

​Specific: Contra in Pheo or V-Fib, relative in PVD
Increases renal blood flow in low dose [does not prevent renal dysfxn or death]

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3
Q

Ephedrine Dynamic; Elim; Specifics

A

Dynamic: NE release at sympathic nerve ending -> A+B
BP inc by CO + SVR;

Elim: Renal (unchanged)

​Specific:
CNS stimulation; Dec uterine activity and mild bronchodilation
Only with pts with normal catecholamine stores
Ineffective to MAOI takers Less effective with repetative doses (NE depletion)

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4
Q

Isoproterenol: Dynamic; Elim; Specifics, Indicates

A

Dynamic: Nonselective B Agon, potent chronictrop+ionotrop. More systemic vasodilate.

Elim: Hepatic + Pulm via MAO/COMT; 40-50% Renal excrete
Indicates: AV blocks +/- ventricular arrhythmia; Shock, Bronchospasm during anes; CHF + BradyC

​Specific:
Increases Myocardial O2 Demand,
Can trigger asthma attack (B2)
Avoid in Digitalis; TachyA; MAOI/TCA

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5
Q

Phenylephrine Dynamic; Elim; Specifics

A

Dynamic: Alpha 1 Receptor only,
Elim: Hepatic and intestinal wall metabolism; Renal Elimination

​Specifics:
Useful also in Tetraology of Fallot Spells
Effective in Neuroaxial block; Outflow tract obstruction in HOCM
Causes Reflex Bradycardia, Microcirculation constriction
Uterine Contraction +/- Vasoconstriction
Decreases CO in CAD pts.
Caution in pts taking MAOI or TCA or Closed-angel glaucoma

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6
Q

Levophed Dynamic; Elim; Specifics

A

Dynamic: Precusor of EPI; Potent Alpha Adrenergic, modest B-adrenergic; Alpha potency Inc with doses >4-5 mcg/min; Positive Iontropy with min-chronotropy
Elim: MAO/COMT metabolism
Useful in septic shock. but not useful in MI relatred shock

​Specific: May cause Uterine contraction Inc,
Constricts micorcirculations, possibly splanic ciruclation
Cardiotoxic in prolong doses and use with care in MAOI pts

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7
Q

Vasopressin Dynamic; Elim; Specifics

A

Indications: DIabetic INsipidus, Abdominal distention
Postcardiotomy and vasodilatory shock (second line); Pulseless Vtach/Fib

Dynamic: V1 Receptor smooth muscle constriction, vasoconstrict of splanichnic, coronary, muscular and cutaneous
V2: Increase Urine osmolarity, Decrease Urine Output
Elim: Hepatic + renal Metabolism with Renal Elimination

​Specific:
Potential Intestinal/Skin Ischemia,
Water intoxication, Pulm Edema,
Abdominal Cramps, Gallbladder Contrction;

Possible Anaphylaxsis

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8
Q

Amrinone Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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9
Q

Mirnone: Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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10
Q

Phenoxybenazmine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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11
Q

Phentolamine Onset; Duration, Dose

A

Dynamic:
Elim:

​Specific

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12
Q

Labetalol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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13
Q

Metoprolol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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14
Q

Esmolol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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15
Q

Propanolol Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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16
Q

Clonidine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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17
Q

Methyldopa Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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18
Q

Diltazem Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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19
Q

Verapamil Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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20
Q

Nicardipine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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21
Q

Clevidipine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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22
Q

Fenoldopam Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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23
Q

Hydralazine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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24
Q

Isosorbide Dinitrate Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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25
Q

Nitroglycerin Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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26
Q

Nitroprusside Sodium Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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27
Q

Adenosine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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28
Q

Amiodarone Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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29
Q

Lidocaine Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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30
Q

Procainamide Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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31
Q

Digioxin Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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32
Q

Nesiritide Dynamic; Elim; Specifics

A

Dynamic:
Elim:

​Specific

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33
Q

phenoxybenzamine leading to paradoxical inc BP and HR (why)

A

due to alpha2 blockade, leading to inc NE release

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34
Q

Diuretic Effect on CHF

A

Dilating Venous Capacitance -> Dec MAP + LV end diastolic vol -> Increased contractility, decrease myocardial wall stress,

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35
Q

MOA of digioxin and what can potentiate this effect

A

Na/K atpase inhibitor -> decrease ca removal via na/ca -> ca sequestered into SR by ca atpase. Anything that leads to hypokalemia will potentiate this effect.

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36
Q

Levosimedan MOA and benefits

A

Calcium Sensitzer of cardaic myocyte by binding to troponin c, and improves cardiac contractility without inc in itnracellular calcium. ALong with vasodilatory (opening atp-k channel in vascular smooth muscle) inc contraction while dec afterload and preload

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37
Q

tolvaptan

A

vasopressin receptor antagonist for SIADH

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38
Q

Theophyilline AE

A

SZ and arrhymogenic,

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39
Q

Effect of LA systemic tox on heart

A

blockade of intracellular site of NA channel. leading to prolong PR and widening of qrs. and impair recovery of sodium channels during hyperpolarization

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40
Q

Dobutamine Use

A

cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.

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41
Q

Lasix AE

A

Low K, Cl, H,

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42
Q

Acetazolamide, MOA AE

A

inhib carbonic anhydrase; can lead to mild hyperchloremic MAcidosis

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43
Q

Mirinone MOA AE,

A

Phosdiesterase 3-I (cAMP only -> inotropy with Lusitropy) Benefit: Inc Cardiac Index without Inc O2 Demand. Synergenistic with adrenergic but cannot be inhbited by blockers. Reduces Systemic+pulm vasc resistance+ AE: Renal Excreted, TachyC, Hypotension, high dose -> Afib.

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44
Q

Nicardipine Cardiovascular effects and Pulm; Contra

A

Vasodilation (CCB); Promote sympathetic response ( chronotropic+ionotropic); Inc FEV1, FVC ; Contra: Prolong 1/2 life in Liver Dz pt. May cause Direct Cerebral Vasodilation without inc ICP or major CBF

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45
Q

Fenoldopam MOA and Special

A

Dopamine-1 Agonist only; increases renal flow while being anti htn.

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46
Q

Esmolol Degradation and Selectivity

A

B1 Selective; metabolized by RBC esterases

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47
Q

ATenolol metabolism

A

Renally cleared (ATN)

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48
Q

Cardiac Drug to avoid IM?: Atropine, Glyco, Ephedrine, EPI, NE, Phenyl, Hydralazine

A

Mostly Vasoactive Meds e.g. NE due to acute tissue ischemia

49
Q

Precedex Metabolism site and selectivism with MOA

A

Liver; a2-a1: 1600:1; MOA: Presynaptic NE release @ peripheral and CNS (spinal + locus creuleus @brain stem). Analgesia, Sedation, and sympatholysis.

50
Q

Methylene Blue use in OR; and Contra

A

Methemoglinemia; Catecholamine-Resistant Vasoplegic Shock (inhib inducible isoform of NO-synthase; Guanylate cyclase -> less NO); Contra: It is inhibitors of MAO-I (esp A type); May preciptate serotonin syndrome if given SSRI or SNRI, or MAOI. G6PD Deficient Indivudal.

51
Q

Nifdepine Contra

A

Cirrhosis (mesenteric vasodilation -> portal hypotension worsen)

52
Q

Clevidipine Special and Metabolism

A

Ultrashort (5-15 min) Dihydropyridine CCB with arteriolar vasodilation. used for severe HTN metabolized by plasma and RBC esterases

53
Q

CCB side effects

A

Peripheral Edema, Flushing and Headache. Potentiator of All types of Muscle NMBD

54
Q

Drug Type Verapamil and special

A

Phenylalkylamine; Intraarterial with Cerebral vasospasm with Local Anes effect. Marked AV node and some SA Depression

55
Q

Drug Type Diltiazem And specials

A

Benzothiazepine; Afib Use, Moderate AV depression and slight SA

56
Q

Nondihydropyridnes Effects

A

Myocardial Depression, SA/AV node Depression -> Decrease HR

57
Q

Metabolism of CCB

A

All are by Liver except Clevidpine

58
Q

CCB for Preg, heart, CVA

A

Gest HTN: Nifdepine; Coronary Vasospasm: Nicardipine; Nimodipine: CVA

59
Q

Initial Effect of Precedex at Bolus of 2 mcg/kg

A

Decrease Central Symp tone + Inc parasymp + Reset baroreceptor to lower set bp -> CO, Dec HR (2/2 a2 and inc bp), Inc BP @ 3 min.with return at 10 min.

60
Q

precedex infusion effect

A

slight bp dec, but co and hr are still low.

61
Q

Lisinopril Effects on Heart

A

Decrease Cardiomyocyte proliferation and fibroblast activity via Reducing AT1 Receptor stimulation

62
Q

Dobutamine Use

A

cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.

63
Q

fenoldopam MOA and Special

A

D1 agonist, Natriuretic, Diuretic, Direct Renal Vasodialtor

64
Q

scopolamine vs atropine in AE

A

Increase risk of central anticholinergic syndrome (crosses bbb better)

65
Q

Amiodarone AE

A

bradycardia, hypotension, Prolong QT, hypothyroidism, life-threatening hyperthyroid storm, pulmonary toxicity (with a pulmonary fibrosis appearance and TB like sx, correlate with total dose given vs daily dose), prolonged QT interval, and elevated liver function markers, blue-grey pigmentation

66
Q

adenosine dosing

A

6 then 12 if piv, 3 then 6 if cvc

67
Q

Lasix AE

A

Low K, Cl, H,

68
Q

Acetazolamide, MOA AE

A

inhib carbonic anhydrase; can lead to mild hyperchloremic MAcidosis

69
Q

Mirinone MOA AE,

A

Phosdiesterase 3-I (cAMP only -> inotropy with Lusitropy) Benefit: Inc Cardiac Index without Inc O2 Demand. Synergenistic with adrenergic but cannot be inhbited by blockers. Reduces Systemic+pulm vasc resistance+ AE: Renal Excreted, TachyC, Hypotension, high dose -> Afib.

70
Q

Nicardipine Cardiovascular effects and Pulm; Contra

A

Vasodilation (CCB); Promote sympathetic response ( chronotropic+ionotropic); Inc FEV1, FVC ; Contra: Prolong 1/2 life in Liver Dz pt. May cause Direct Cerebral Vasodilation without inc ICP or major CBF

71
Q

Fenoldopam MOA and Special

A

Dopamine-1 Agonist only; increases renal flow while being anti htn.

72
Q

Esmolol Degradation and Selectivity

A

B1 Selective; metabolized by RBC esterases

73
Q

ATenolol metabolism

A

Renally cleared (ATN)

74
Q

Cardiac Drug to avoid IM?: Atropine, Glyco, Ephedrine, EPI, NE, Phenyl, Hydralazine

A

Mostly Vasoactive Meds e.g. NE due to acute tissue ischemia

75
Q

Precedex Metabolism site and selectivism with MOA

A

Liver; a2-a1: 1600:1; MOA: Presynaptic NE release @ peripheral and CNS (spinal + locus creuleus @brain stem). Analgesia, Sedation, and sympatholysis.

76
Q

Methylene Blue use in OR; and Contra

A

Methemoglinemia; Catecholamine-Resistant Vasoplegic Shock (inhib inducible isoform of NO-synthase; Guanylate cyclase -> less NO); Contra: It is inhibitors of MAO-I (esp A type); May preciptate serotonin syndrome if given SSRI or SNRI, or MAOI. G6PD Deficient Indivudal.

77
Q

Nifdepine Contra

A

Cirrhosis (mesenteric vasodilation -> portal hypotension worsen)

78
Q

Clevidipine Special and Metabolism

A

Ultrashort (5-15 min) Dihydropyridine CCB with arteriolar vasodilation. used for severe HTN metabolized by plasma and RBC esterases

79
Q

CCB side effects

A

Peripheral Edema, Flushing and Headache. Potentiator of All types of Muscle NMBD

80
Q

Drug Type Verapamil and special

A

Phenylalkylamine; Intraarterial with Cerebral vasospasm with Local Anes effect. Marked AV node and some SA Depression

81
Q

Drug Type Diltiazem And specials

A

Benzothiazepine; Afib Use, Moderate AV depression and slight SA

82
Q

Nondihydropyridnes Effects

A

Myocardial Depression, SA/AV node Depression -> Decrease HR

83
Q

Metabolism of CCB

A

All are by Liver except Clevidpine

84
Q

CCB for Preg, heart, CVA

A

Gest HTN: Nifdepine; Coronary Vasospasm: Nicardipine; Nimodipine: CVA

85
Q

Initial Effect of Precedex at Bolus of 2 mcg/kg

A

Decrease Central Symp tone + Inc parasymp + Reset baroreceptor to lower set bp -> CO, Dec HR (2/2 a2 and inc bp), Inc BP @ 3 min.with return at 10 min.

86
Q

precedex infusion effect

A

slight bp dec, but co and hr are still low.

87
Q

Lisinopril Effects on Heart

A

Decrease Cardiomyocyte proliferation and fibroblast activity via Reducing AT1 Receptor stimulation

88
Q

Dobutamine Use

A

cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.

89
Q

fenoldopam MOA and Special

A

D1 agonist, Natriuretic, Diuretic, Direct Renal Vasodialtor

90
Q

scopolamine vs atropine in AE

A

Increase risk of central anticholinergic syndrome (crosses bbb better)

91
Q

Amiodarone AE

A

bradycardia, hypotension, Prolong QT, hypothyroidism, life-threatening hyperthyroid storm, pulmonary toxicity (with a pulmonary fibrosis appearance and TB like sx, correlate with total dose given vs daily dose), prolonged QT interval, and elevated liver function markers, blue-grey pigmentation

92
Q

adenosine dosing

A

6 then 12 if piv, 3 then 6 if cvc

93
Q

Lasix AE

A

Low K, Cl, H,

94
Q

Acetazolamide, MOA AE

A

inhib carbonic anhydrase; can lead to mild hyperchloremic MAcidosis

95
Q

Mirinone MOA AE,

A

Phosdiesterase 3-I (cAMP only -> inotropy with Lusitropy) Benefit: Inc Cardiac Index without Inc O2 Demand. Synergenistic with adrenergic but cannot be inhbited by blockers. Reduces Systemic+pulm vasc resistance+ AE: Renal Excreted, TachyC, Hypotension, high dose -> Afib.

96
Q

Nicardipine Cardiovascular effects and Pulm; Contra

A

Vasodilation (CCB); Promote sympathetic response ( chronotropic+ionotropic); Inc FEV1, FVC ; Contra: Prolong 1/2 life in Liver Dz pt. May cause Direct Cerebral Vasodilation without inc ICP or major CBF

97
Q

Fenoldopam MOA and Special

A

Dopamine-1 Agonist only; increases renal flow while being anti htn.

98
Q

Esmolol Degradation and Selectivity

A

B1 Selective; metabolized by RBC esterases

99
Q

ATenolol metabolism

A

Renally cleared (ATN)

100
Q

Cardiac Drug to avoid IM?: Atropine, Glyco, Ephedrine, EPI, NE, Phenyl, Hydralazine

A

Mostly Vasoactive Meds e.g. NE due to acute tissue ischemia

101
Q

Precedex Metabolism site and selectivism with MOA

A

Liver; a2-a1: 1600:1; MOA: Presynaptic NE release @ peripheral and CNS (spinal + locus creuleus @brain stem). Analgesia, Sedation, and sympatholysis.

102
Q

Methylene Blue use in OR; and Contra

A

Methemoglinemia; Catecholamine-Resistant Vasoplegic Shock (inhib inducible isoform of NO-synthase; Guanylate cyclase -> less NO); Contra: It is inhibitors of MAO-I (esp A type); May preciptate serotonin syndrome if given SSRI or SNRI, or MAOI. G6PD Deficient Indivudal.

103
Q

Nifdepine Contra

A

Cirrhosis (mesenteric vasodilation -> portal hypotension worsen)

104
Q

Clevidipine Special and Metabolism

A

Ultrashort (5-15 min) Dihydropyridine CCB with arteriolar vasodilation. used for severe HTN metabolized by plasma and RBC esterases

105
Q

CCB side effects

A

Peripheral Edema, Flushing and Headache. Potentiator of All types of Muscle NMBD

106
Q

Drug Type Verapamil and special

A

Phenylalkylamine; Intraarterial with Cerebral vasospasm with Local Anes effect. Marked AV node and some SA Depression

107
Q

Drug Type Diltiazem And specials

A

Benzothiazepine; Afib Use, Moderate AV depression and slight SA

108
Q

Nondihydropyridnes Effects

A

Myocardial Depression, SA/AV node Depression -> Decrease HR

109
Q

Metabolism of CCB

A

All are by Liver except Clevidpine

110
Q

CCB for Preg, heart, CVA

A

Gest HTN: Nifdepine; Coronary Vasospasm: Nicardipine; Nimodipine: CVA

111
Q

Initial Effect of Precedex at Bolus of 2 mcg/kg

A

Decrease Central Symp tone + Inc parasymp + Reset baroreceptor to lower set bp -> CO, Dec HR (2/2 a2 and inc bp), Inc BP @ 3 min.with return at 10 min.

112
Q

precedex infusion effect

A

slight bp dec, but co and hr are still low.

113
Q

Lisinopril Effects on Heart

A

Decrease Cardiomyocyte proliferation and fibroblast activity via Reducing AT1 Receptor stimulation

114
Q

Dobutamine Use

A

cardiogenic shock with maintaining BP as it improves cardiac output and reduces afterload with minimal increase in myocardial oxygen demand.

115
Q

fenoldopam MOA and Special

A

D1 agonist, Natriuretic, Diuretic, Direct Renal Vasodialtor

116
Q

scopolamine vs atropine in AE

A

Increase risk of central anticholinergic syndrome (crosses bbb better)

117
Q

amiloride ae:

A

Diuresis via blocking na channel hyperkalemia, nv, rash, headache

118
Q

Amiodarone AE

A

bradycardia, hypotension, Prolong QT, hypothyroidism, life-threatening hyperthyroid storm, pulmonary toxicity (with a pulmonary fibrosis appearance and TB like sx, correlate with total dose given vs daily dose), prolonged QT interval, and elevated liver function markers, blue-grey pigmentation

119
Q

adenosine dosing

A

6 then 12 if piv, 3 then 6 if cvc

Pharmacology (21 decks)

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